IMMUNIZATIONSAND VACCINATIONS

Chickenpox (Varicella) Vaccine

Chickenpox vaccine is a routine immunization for all children in the USA. All children should receive one dose of chickenpox vaccine between 12 and 18 months of age, or at any age after that, if they have never had chickenpox. Adults and adolescents 13 years of age or older should receive 2 doses of the vaccine, 4-8 weeks apart. Chickenpox vaccine should not be given during pregnancy, and female patients should not become pregnant for at least 1 month after immunization.

Chickenpox is a viral infection that is highly contagious and usually quite mild, but it can be serious, especially in young infants and adults. Any person who has ever had chickenpox in the past has lifelong immunity and does not need this vaccine. Once otherwise healthy people contact chickenpox, the disease rarely ever occurs a second time. Before the availability of the vaccine in 1995, approximately 10,000 persons with chickenpox required hospitalization every year in the USA; close to 100 deaths from chickenpox occurred annually.

Hepatitis B Vaccine

Hepatitis B vaccine is a routine immunization for all children and adolescents in the USA who are 18 years of age and younger. Hepatitis B vaccine is a 3-dose series with 1 month recommended between dose 1 and 2, and 5 months recommended between dose 2 and 3. The duration of protection is many years and there is no specific booster recommendation at this time.

In May, 2001 the FDA licensed and approved a new combination hepatitis A and hepatitis B vaccine for adults 18 years of age and older. It is recommended for persons who are, or will be, at risk of infection with hepatitis A and B viruses. It is administered in 3 doses, 1 each at 0, 1, and 6 months. At this time, the cost of the vaccine is not covered by any medical insurance plan.

Hepatitis B is a serious viral infection of the liver transmitted by blood, blood products, objects contaminated with blood, and sexual contact. It can also be transferred from mother to infant at the time of birth, but it is not transmitted by breastfeeding. Hepatitis B infection can cause chronic liver disease, including cancer of the liver. When an infant contracts the disease at birth, it will cause a chronic carrier state up to 90% of the time and serious liver disease up to 25% of the time.

Measles-Mumps-Rubella (MMR) Vaccines

MMR vaccine is a routine childhood immunization in the USA. This is a 2-dose series given initially on or after the 1st birthday and again at 4-6 years of age, but it is acceptable to give the 2 doses any time with as little as 1 month between them. The MMR vaccine should not be given during pregnancy, and female patients should not become pregnant for at least 1month after immunization. For babies age 6-11 months traveling to countries where measles is endemic (e.g., India), a single dose of monovalent measles vaccine (MMR is acceptable) is recommended. If the vaccine is given at age 6-11 months, a routine MMR is still recommended at age 1 year or as soon after as practical.

Measles, mumps and rubella (German measles) are highly contagious, viral diseases that are rare in the USA because of the high level of childhood immunization rates. Immunization of adolescents and young adults with a rubella-containing vaccine is especially important in preventing congenital rubella syndrome (CRS).

Meningococcal Vaccine

Meningococcal vaccine should be considered for college freshmen, particularly those that plan to live in dormitories. Some colleges require meningococcal vaccine for entering freshmen. All colleges should provide information about meningococcal disease and the availability of the vaccine. Meningococcal vaccine is a single dose injection. It is recommended for international travelers to the "meningitis belt" of Africa from December through June and pilgrims returning to the Hajj or Umra in Saudi Arabia. Outbreaks occur intermittently in India, Mongolia, Nepal, and Pakistan. It is also indicated for people 2 years of age or older who lack a spleen or suffer from some immune deficiencies. A booster dose, when indicated, is recommended 2-5 years later.

Meningococcal infections, usually meningitis, are serious bacterial infections with a 10% fatality rate. The infection is most common in children and young adults and people living in crowded conditions. Intimate contact and airborne contamination from infected individuals spread the disease. Some people are carriers of the disease but are not sick themselves.

Pneumococcal Vaccines

Another pneumococcal vaccine, called pneumococcal polysaccharide vaccine (PPV23), is a routine immunization for all adults over age 65. It is never used in children under 2 years of age, but it is sometimes recommended for people over 2 years of age who are at risk for pneumococcal bacterial infections.

Pneumococcal disease may cause meningitis, pneumonia, middle ear infections, and other serious infections. The highest rates of these pneumococcal infections occur in children under 2 years of age and adults over 40 years old.

Tetanus-Diphtheria Acellular Pertussis (Tdap) Vaccine

Td vaccine is a routine childhood immunization in the USA for those 7 years of age and older. Following completion of theDTaP, DTP, or DT series (by the 7th birthday), Tdap is given at 11-12 years of age if at least 5 years have elapsed since the last dose of DTaP, DTP or DT. Subsequent Tdap boosters are recommended every 10 years.

Tetanus, or lockjaw, is a very serious disease that may follow a cut, burn or wound. It causes serious muscle spasms and frequently ends in death. Diphtheria is a serious disease characterized by a very sore throat, difficulty breathing, paralysis, and heart failure. Both diseases are very rare in the USA because of the high immunization rates in children and young adults.